Objective To observe the clinical efficacy of extracorporeal shock wave(ESWT)combined with Mulligan technique in the treatment of early to middle stage knee osteoarthritis(KOA)in elderly patients.Methods From July 2021 to December 2022,a total of 96 elderly patients with KOA admitted to the Rehabilitation Medicine Department of Changzhou Wujin People's Hospital were selected as the study objects.They were divided into the control group and the observation group with 48 cases each according to the random number table method.The control group received extracorporeal shock wave therapy,while the observation group received extracorporeal shock wave therapy combined with Mulligan technique.The visual analogue scales (VAS),joint swelling scores,range of motion (ROM),and The Western Ontario and McMaster Universities(WOMAC)osteoarthritis index scores were observed before and after a course of treatment in both groups.Results After one course of treatment,the total effective rate of the observation group was higher than that of the control group,and the difference was statistically significant(P＜0.05).After one course of treatment,the VAS,joint swelling scores,and WOMAC scores in the observation group were lower than those in the control group,and the knee joint ROM was higher than that in the control group,and the differences were statistically significant(P＜0.05).Conclusion The combination of extracorporeal shock wave and Mulligan technology can better improve pain and mobility in the early and middle stages of KOA patients.